The goal of this R34 developmental grant is to adapt and pilot an evidence-based integrated approach to the management of psychiatric and medical illness in middle-aged and older persons with severe mental illness (SMI) and chronic medical conditions. This application responds to a pressing public health need by adapting and piloting a model of Integrated Illness Management and Recovery (I-IMR) to enhance mental and physical health outcomes. I-IMR targets improved management of psychiatric and medical illness by a) improving consumers' illness self-management skills by adapting IMR to include psychiatric and medical illness management skills training and b) improving access and coordination of evidence-based health care enough an integrated model of health care management embedded in the mental health service delivery setting. Following model development and feasibility pilot testing of I-IMR, we will conduct a randomized, controlled pilot trial in 50 persons age 50+ with SMI and medical comorbidity, comparing 25 participants receiving I-IMR to 25 participants receiving usual care. Primary outcome measures include: psychiatric and medical illness self management skills, medication adherence, and quality of evidence-based health care for diabetes, hyperlipidemia, and hypertension, and quality of preventive health care. This proposal addresses the gap between research on effective services and implementation into routine practice settings by capitalizing on a long-standing collaboration between NH's Bureau of Behavioral Health and the NH-Dartmouth Psychiatric Research Center. Implementation of IMR and integrated mental health and primary care services has been identified as a priority by the State of New Hampshire, the National Association of State Mental Health Program Directors, and the recent President's New Freedom Commission on Mental Health. As such, this application responds to the call by the NIMH-SAMHSA Science Service initiative to adapt existing EBPs to new priority populations identified by state mental health authorities and to develop effective strategies for implementation by routine providers in usual care settings.